HomeMy Public PortalAbout6057 ENCINITA AVE_Sewer__ CEB°83-82
TBA6<20 APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING O
JOHN A, LAMBIE, County Engineer A°DRESS
WILLIAM A. JENSEN, Supt of Building
wcAury • ,[s
NEAREST /
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. ,} •/I OWNER ��( • „��sri
MAIL
BLOCK TRACT (�`f ADDRESS
NO. OF BLOGS.
512E OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS DISTRICT NO, GROUP MAP P E55ED BY
BK PG
ADDRESS + utj CONNECTION DATA
STATION (, DEPTH
-/y f ry _ STATE MA NHO LE REFERENCE G
REGISTRATION NO_ 6// f CDUNTY _ LOWER
NO. DESCRIPTION OF WORK FEE qq ,�'I. TYPE OF CO TION I LENGTH FROM
HOUSE SEWER CONNECTING TO Y URB.' 1.L. M.L.TO P.L.
PUBLIC SEWER E5.00
NO.
SEPTIC TANK.SEEPAGE PIT OR
JOB
PITS AND/OR GRAINFIELD I@ E10.00 CO.IMP. NO, f/_J^=Jr'� JOB NO. u
HOUSE SEWER CONNECTING TO I TRUNK PERMIT NO. ROAD PERMIT NO
PRIVATE CONNECTDISPOSAL SYSTEM $3.00
CONNECT HOUSE SEWER
BLDG.OR AFFIDAVIT AIV I.SEM[x RECORD,INBTR,NO, DATE
1 WORK TO HOUSE SEWER � E3.00 Ij M' E• E
OVERFLOW SEEPAGE PIT.GRAINFIELD
EXTN..CESSPOOL.DRYWELL.MANHOLE $5.00
ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING
SEWER Ofl DISPOSAL SYSTEM 53.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
rP{O ViNER'S PERMIT S1 z oo CHARGES
AUTHORIZATION TOTAL FEEf1lT CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMEDI CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING ,
TO THE PUBLIC SEY+P}+ APPROVALS A
DATE INSPECTOR'S SIGNATURE
SIGNED THIS Gp DAV OF �J��r 19L� /� ���I
OWNER°R NEW HOUSE SEWER
OWNERS AGENT J CONNECT ADDITIONAL '
BUILDING OR WORK
ADDRESS
SEPTIC TANKSEEP, PIT IS)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATI AND/OR GRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL El °RYWELL El
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR ALTER.RE PAIR.SEWER ON
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF : SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I . THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND
RESIDE IN. THE ABOV DESCR ED RESIDENTI PROPERTY. ABANDON HOUSE 5EW ER
SIGNATURE ^/
OF PERMITTEE - BACKFILL SEPTIC TANKS ❑ ` �% ! //y/J
[ ACA
PITISI ❑ CESSPOOLS
VALIDATIO ROBERT A. IWOOD
CH. M.o. cwSH SUPERVISING MECHANICAL ENGINEER
LI'd o i 1 8 8:2 FEB 21 1 0 D 7,0
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